MSS Ch 9: Renal/GU Disorders Practice Questions

Question 1

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview?

1. “Have you recently traveled outside the United States?”
2. “Did you recently begin a vigorous exercise program?”
3. “Is there a chance you have been exposed to a virus?”
4. “What over-the-counter medications do you take regularly?”

Answer 1

1. Usually there are no diseases or conditions warranting this question when discussing ARF.
2. Vigorous exercise will not impede blood flow to the kidneys, leading to ARF.
3. Usually viruses do not cause ARF.
4. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate.

Question 2

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF?

1. BUN and creatinine.
2. WBC and hemoglobin.
3. Potassium and sodium.
4. Bilirubin and ammonia level.

Answer 2

1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal sub- stance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.
2. WBCs (white blood cells) are monitored for infection, and hemoglobin is monitored for blood loss.
3. Potassium (intracellular) and sodium (interstitial) are electrolytes and are monitored for a variety of diseases or conditions not specific to renal function. Potassium levels will increase with renal failure, but the level is not a diagnostic indicator for renal failure.
4. Bilirubin and ammonia levels are laboratory values determining the function of the liver, not the kidneys.

Question 3

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure?

1. Diabetes mellitus.
2. Hypotension.
3. Aminoglycosides.
4. Benign prostatic hypertrophy.

Answer 3

1. Diabetes mellitus is a disease which may lead to chronic renal failure.
2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney).
3. Nephrotoxic medications are a cause of intrarenal failure (directly to kidney).
4. Benign prostatic hypertrophy (BPH) is a cause of postrenal failure (after the kidney).

Question 4

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply.

1. Increased alertness and no seizure activity.
2. Increase in hemoglobin and hematocrit.
3. Denial of nausea and vomiting.
4. Decreased urine-specific gravity.
5. Increased serum creatinine level.

Answer 4

1. Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity.
2. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit in- dicates the client is in the recovery period.
3. Nausea, vomiting, and diarrhea are common in the client with ARF; there- fore, an absence of these indicates the client is in the recovery period.
4. The client in the recovery period has an increased urine-specific gravity.
5. The client in the recovery period has a decreased serum creatinine level.

Question 5

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client?

1. Administer a phosphate binder.
2. Type and crossmatch for whole blood.
3. Assess the client for leg cramps.
4. Prepare the client for dialysis.

Answer 5

1. Phosphate binders are used to treat elevated phosphorus levels, not elevated potassium levels.
2. Anemia is not the result of an elevated potassium level.
3. Assessment is an independent nursing action, which is appropriate for the elevated potassium level, but the question asks for a collaborative treatment.
4. Normal potassium level is 3.5 to 5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-care provider order, so it is a collaborative intervention.

Question 6

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client?

1. Monitor intake and output every shift.
2. Decrease of pain by 3 levels on a 1–10 scale.
3. Electrolytes are within normal limits.
4. Administer enemas to decrease hyperkalemia.

Answer 6

1. This is a nursing intervention, not a client outcome.
2. This is a measurable client outcome, but acute renal failure does not cause pain.
3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.
4. A Kayexalate resin enema may be adminis- tered to help decrease the potassium level, but this is an intervention, not a client outcome.

Question 7

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client?

1. A high-potassium and low-calcium diet.
2. A low-fat and low-cholesterol diet.
3. A high-carbohydrate and restricted-protein diet.
4. A regular diet with six (6) small feedings a day.

Answer 7

1. The diet is low potassium, and calcium is not restricted in ARF.
2. This is a diet recommended for clients with cardiac disease and atherosclerosis.
3. Carbohydrates are increased to provide for the client’s caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.
4. The client must be on a therapeutic diet, and small feedings are not required.

Question 8

The client diagnosed with ARF is placed on bedrest. The client asks the nurse, “Why do I have to stay in bed? I don’t feel bad.” Which scientific rationale supports the nurse’s response?

1. Bedrest helps increase the blood return to the renal circulation.
2. Bedrest reduces the metabolic rate during the acute stage.
3. Bedrest decreases the workload of the left side of the heart.
4. Bedrest aids in reduction of peripheral and sacral edema.

Answer 8

1. Kidney function is improved about 40% when recumbent, but this is not the scientific rationale for bedrest in ARF.
2. Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).
3. This is a scientific rationale for prescribing bedrest in clients with heart failure.
4. This is not the scientific rationale for prescribing bedrest. The foot of the bed may be elevated to help decrease peripheral edema, and bedrest causes an increase in sacral edema.

Question 9

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate?

1. Collect a clean voided midstream urine specimen.
2. Evaluate the client’s 8-hour intake and output.
3. Assist in checking a unit of blood prior to hanging.
4. Administer a cation-exchange resin enema.

Answer 9

1. The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container.
2. The UAP can obtain the client’s intake and output, but the nurse must evaluate the data to determine if interventions are needed or if interventions are effective.
3. Two registered nurses must check the unit of blood at the bedside prior to administering it.
4. This is a medication enema and UAPs cannot administer medications. Also, for this to be ordered, the client must be unstable with an excessively high serum potassium level.

Question 10

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF?

1. Administer normal saline IV.
2. Take vital signs.
3. Place client on telemetry.
4. Assess abdominal dressing.

Answer 10

1. Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound.
2. Taking and evaluating the client’s vital signs is an appropriate action, but regardless of the results, this will not prevent ARF.
3. Placing the client on telemetry is an appropriate action, but telemetry is an assessment tool for the nurse and will not prevent ARF.
4. Assessment is often the first action, but assessing the abdominal dressing will not help prevent ARF.

Question 11

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement?

1. Have the assistant apply a moisture barrier cream to the skin.
2. Instruct the UAP to bathe the client in cool water.
3. Tell the UAP not to turn the client in this condition.
4. Explain this is normal and do not do anything for the client.

Answer 11

1. Moisture barrier cream will keep the crystals on the skin.
2. These crystals are uremic frost resulting from irritating toxins deposited in the client’s tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.
3. The client should be turned every two (2) hours or more frequently to prevent skin breakdown.
4. This may occur with ARF, and it does require a nursing intervention.

Question 12

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level?

1. Erythropoietin.
2. Calcium gluconate.
3. Regular insulin.
4. Osmotic diuretic.

Answer 12

1. Erythropoietin is a chemical catalyst produced by the kidneys to stimulate red blood cell production; it does not affect potassium level.
2. Calcium gluconate helps protect the heart from the effects of high potassium levels.
3. Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily.
4. A loop diuretic, not an osmotic diuretic, may be ordered to help decrease the potassium level.

Question 13

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client?
1. There is an increased excretion of phosphates and organic acids, which leads to an
increase in arterial blood pH.
2. A shortened life span of red blood cells because of damage secondary to dialysis
treatments in turn leads to metabolic acidosis.
3. The kidney cannot excrete increased levels of acid because they cannot excrete
ammonia or cannot reabsorb sodium bicarbonate.
4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the
respiratory system cannot compensate adequately.

Answer 13

1. There is a decrease in the excretion of phosphates and organic acids, not an increase.
2. The red blood cell destruction does not affect the arterial blood pH.
3. This is the correct scientific rationale for metabolic acidosis occurring in the client with CKD.
4. This compensatory mechanism occurs to maintain an arterial blood pH between 7.35 and 7.45, but it does not occur as a result of CKD.

Question 14

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first?

1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%.
2. The client who does not have a palpable thrill or auscultated bruit.
3. The client who is complaining of being exhausted and is sleeping.
4. The client who did not take antihypertensive medication this morning.

Answer 14

1. These laboratory findings are low but do not require a blood transfusion and often are expected in a client who is anemic secondary to ESRD.
2. This client’s dialysis access is compromised and he or she should be assessed first.
3. It is not uncommon for a client undergoing dialysis to be exhausted and sleep through the treatment.
4. Clients are instructed not to take their antihypertensive medications before dialysis to help prevent episodes of hypotension.

Question 15

The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, 1 week ago. Which complaint by the client indicates the need to notify the health-care provider?

1. The client complains of flu-like symptoms.
2. The client complains of being tired all the time.
3. The client reports an elevation in his blood pressure.
4. The client reports discomfort in his legs and back.

Answer 15

1. Flu-like symptoms are expected and tend to subside with repeated doses; the nurse should suggest Tylenol prior to the injections.
2. This medication takes up to two (2) to six (6) weeks to become effective in improving anemia and thereby reducing fatigue.
3. After the initial administration of erythropoietin, a client’s antihyperten- sive medications may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is contraindi- cated in clients with uncontrolled hypertension.
4. Long bone and vertebral pain is an expected occurrence because the bone marrow is being stimulated to increase production of red blood cells.

Question 16

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client?

1. Low self-esteem.
2. Knowledge deficit.
3. Activity intolerance.
4. Excess fluid volume.

Answer 16

1. Low self-esteem, related to dependency, role changes, and changes in body image, is a pertinent client problem, but psychosocial problems are not priority over physiological problems.
2. Teaching is always an important part of the care plan, but it is not priority over a physiological problem.
3. Activity intolerance related to fatigue, anemia, and retention of waste products is a physiological problem, but it is not a life-threatening problem.
4. Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death.

Question 17

The client with CKD is placed on a fluid restriction of 1,500 mL/day. On the 7 a.m. to 7 p.m. shift the client drank an eight (8)-ounce cup of coffee, 4 ounces of juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid
can the 7 p.m. to 7 a.m. nurse give to the client? _____________

Answer 17

Answer: 720 mL.

The nurse must add up how many milliliters of fluid the client drank on the 7 a.m. to 7 p.m. shift and then subtract that number from 1,500 mL to determine how much fluid the client can receive on the 7 p.m. to 7 a.m. shift. One (1) ounce is equal to 30 mL. The client drank 26 ounces (8 + 4 + 12 + 2) of fluid, or 780 mL (26 × 30) of fluid. Therefore, the client can have 720 mL (1,500 − 780) of fluid on the 7 p.m. to 7 a.m. shift.

Question 18

The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement?

1. Teach the client to carry heavy objects with the right arm.
2. Perform all laboratory blood tests on the left arm.
3. Instruct the client to lie on the left arm during the night.
4. Discuss the importance of not performing any hand exercises.

Answer 18

1. Carrying heavy objects in the left arm could cause the fistula to clot by putting undue stress on the site, so the client should carry objects with the right arm.
2. The fistula should only be used for dialysis access, not for routine blood draws.
3. The client should not lie on the left arm because this may cause clotting by putting pressure on the site.
4. Hand exercises are recommended for new fistulas to help mature the fistula.

Question 19

The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic?

1. “You cannot just quit your dialysis. This is not an option.”
2. “Your angry at not being on the list, and you want to quit dialysis?”
3. “I will call your nephrologist right now so you can talk to the HCP.”
4. “Make your funeral arrangements because you are going to die.”

Answer 19

1. The client does have the right to quit dialysis if he or she wants to.
2. Reflecting the client’s feelings and re- stating them are therapeutic responses the nurse should use when addressing the client’s issues.
3. This is passing the buck; the nurse should address the client’s issues.
4. This may be true, but it is not therapeutic in attempting to get the client to verbalize feelings.

Question 20

The nurse is discussing kidney transplants with clients at a dialysis center. Which population is less likely to participate in organ donation?

1. Caucasian.
2. African American.
3. Asian.
4. Hispanic.

Answer 20

1. Caucasians are composed of a multitude of cultures but for the most part organ donation is very likely, although individual preferences vary.
2. Many in the African American culture believe the body must be kept intact after death, and organ donation is rare among African Americans. This is also why a client of African American descent will be on a transplant waiting list longer than people of other races. This is because of tissue-typing compatibility. Remember, this does not apply to all African-Americans; every client is an individual.
3. Asians as a culture participate in organ donation.
4. Hispanics as a culture participate in organ donation

Question 21

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first?

1. Place the client in the Trendelenburg position.
2. Turn off the dialysis machine immediately.
3. Bolus the client with 500 mL of normal saline.
4. Notify the health-care provider as soon as possible.

Answer 21

1. The nurse should place the client’s chair with the head lower than the body, which will shunt blood to the brain; this is the Trendelenburg position.
2. The blood in the dialysis machine must be infused back into the client before the machine is turned off.
3. Normal saline infusion is a last resort because one of the purposes of dialysis is to remove excess fluid from the body.
4. Hypotension is an expected occurrence in clients receiving dialysis; therefore, the HCP does not need to be notified.

Question 22

The nurse caring for a client diagnosed with CKD writes a client problem of “noncompliance with dietary restrictions.” Which intervention should be included in the plan of care?

1. Teach the client the proper diet to eat while undergoing dialysis.
2. Refer the client and significant other to the dietitian.
3. Explain the importance of eating the proper foods.
4. Determine the reason for the client not adhering to the diet.

Answer 22

1. Teaching is an intervention for knowledge deficit, not noncompliance.
2. Referring the client does not address the issue of noncompliance.
3. Noncompliance is a client’s choice, and explaining interventions will not necessarily make the client choose differently.
4. Noncompliance is a choice the client has a right to make, but the nurse should determine the reason for the noncompliance and then take appropriate actions based on the client’s rationale. For example, if the client has financial difficulties, the nurse may suggest how the client can afford the proper foods along with medications, or the nurse may be able to refer the client to a social worker.

Question 23

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse?

1. Inability to auscultate a bruit over the fistula.
2. The client’s abdomen is soft, is nontender, and has bowel sounds.
3. The dialysate being removed from the client’s abdomen is clear.
4. The dialysate instilled was 1,500 mL and removed was 1,500 mL.

Answer 23

1. Peritoneal dialysis is administered through a catheter inserted into the peritoneal cavity; a fistula is used for hemodialysis.
2. Peritonitis, inflammation of the peritoneum, is a serious complication resulting in a hard, rigid abdomen. Therefore, a soft abdomen does not warrant immediate intervention.
3. The dialysate return is normally colorless or straw-colored, but it should never be cloudy, which indicates an infection.
4. Because the client is in ESRD, fluid must be removed from the body, so the output should be more than the amount instilled. These assessment data require intervention by the nurse.

Question 24

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client?

1. Notify the HCP if oral temperature is 102 ̊F or greater.
2. Apply ice to the access site if it starts bleeding at home.
3. Keep fingernails short and try not to scratch the skin.
4. Encourage significant other to make decisions for the client.

Answer 24

1. The client should not wait until the temperature is 102 ̊F to call the HCP; the client should call when the temperature is 100 ̊F or greater.
2. The client should apply direct pressure and notify the HCP if the access site starts to bleed, not apply ice to the site.
3. Uremic frost, which results when the skin attempts to take over the function of the kidneys, causes itching, which can lead to scratching possibly resulting in a break in the skin.
4. The nurse should encourage the client’s independence, not foster dependence by encouraging the significant other to make the client’s decision.

Question 25

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these findings?

1. Overhydration.
2. Anemia.
3. Dehydration.
4. Renal failure.

Answer 25

1. Clients who are overhydrated or have fluid volume excess experience dilutional values of sodium (135 to 145 mEq/L) and red blood cells (44% to 52%). The levels are lower than normal, not higher.
2. Anemia is a low red blood cell count for a variety of reasons.
3. Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.
4. In renal failure, the kidneys cannot excrete urine, and this results in too much fluid in the body.

Question 26

The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP?
1. The pump keeps sounding an alarm indicating the high pressure has been
reached.
2. Intake is 1,800 mL, NGT output is 550 mL, and Foley output is 950 mL.
3. On auscultation, crackles and rhonchi in all lung fields are noted.
4. Client has negative pedal edema and an increasing level of consciousness.

Answer 26

1. The pump is alerting the nurse there is resistance distal to the pump; this does not requiring notifying the HCP.
2. The client has an 1,800-mL intake and total output of 1,500 mL. The body has an insensible loss of approximately 400 mL/day through the skin, respirations, and other body functions. This does not warrant notifying the HCP.
3. Crackles and rhonchi in all lung fields indicate the body is not able to process the amount of fluid being infused. This should be brought to the HCP’s attention.
4. Negative pedal edema and an increasing level of consciousness indicate the client is not experiencing a problem.

Question 27

The client diagnosed with diabetes insipidus weighed 180 pounds when the daily weight was taken yesterday. This morning’s weight is 175.6 pounds. One liter of fluid weighs approximately 2.2 pounds. How much fluid has the client lost? _______

Answer 27

2,000 mL has been lost.

First, determine how many pounds the client has lost:
180 − 175.6 = 4.4 pounds lost
Then, based on the fact that 1 liter of fluid weighs 2.2 pounds, determine how many liters of fluid have been lost:
4.4 ÷ 2.2 = 2 liters lost
Then, because the question asks for the answer in milliliters, convert 2 liters into milliliters:
2 × 1,000 = 2,000 mL

Question 28

The nurse writes the client problem of “fluid volume excess” (FVE). Which intervention should be included in the plan of care?

1. Change the IV fluid from 0.9% NS to D5W.
2. Restrict the sodium in the client’s diet.
3. Monitor blood glucose levels.
4. Prepare the client for hemodialysis.

Answer 28

1. The nursing plan of care does not include changing the HCP’s orders.
2. Fluid volume excess refers to an isotonic expansion of the extracellular fluid by an abnormal expansion of water and sodium. Therefore, sodium is restricted to allow the body to excrete the extra volume.
3. High blood glucose levels result in viscous blood and cause the kidneys to try to fix the problem by excreting the glucose through increasing the urine output, which results in fluid volume deficits.
4. If the FVE is the result of renal failure, then hemodialysis may be ordered, but this information was not provided in the stem of the question.

Question 29

The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented?

1. Encourage fluids orally.
2. Administer 10% saline solution IVPB.
3. Administer antidiuretic hormone intranasally.
4. Place on seizure precautions.

Answer 29

1. The client probably will be placed on fluid restriction. Fluids should not be encouraged for a client with a low sodium level (normal: 135 to 145 mEq/L). Hypertonic solutions of saline are 3% to 5%, not 10%, because of the extreme nature of hypertonic solutions.
2. Hypertonic solutions of saline may be used but very cautiously because, if the sodium levels are increased too rapidly, a massive fluid shift can occur in the body, resulting in neurological damage and heart failure.
3. The antidiuretic hormone (vasopressin) causes water retention in the body and increases the problem.
4. Clients with sodium levels less than 120 mEq/L are at risk for seizures as a complication. The lower the sodium level, the greater the risk of a seizure.

Question 30

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first?

1. The client in normal sinus rhythm with a peaked T wave.
2. The client diagnosed with atrial fibrillation with a rate of 100.
3. The client diagnosed with a myocardial infarction who has occasional PVCs.
4. The client with a first-degree atrioventricular block and a rate of 92.

Answer 30

1. A client with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability.
2. Fluctuations in rate are expected in clients diagnosed with atrial fibrillation, and a heart rate of 100 is at the edge of a normal rate.
3. Most people experience an occasional premature ventricular contraction (PVC); this does not warrant the nurse assessing this client first.
4. A first-degree block is not an immediate problem.

Question 31

The client who is post-thyroidectomy complains of numbness and tingling around the mouth and the tips of the fingers. Which intervention should the nurse implement first?

1. Notify the health-care provider immediately.
2. Tap the cheek about two (2) cm anterior to the earlobe. 3. Check the serum calcium and magnesium levels.
3. Prepare to administer calcium gluconate IVP.

Answer 31

1. The HCP may need to be notified, but the nurse should perform assessment first.
2. These are signs and symptoms of hypocalcemia, and the nurse can confirm this by tapping the cheek to elicit the Chvostek’s sign. If the muscles of the cheek begin to twitch, then the HCP should be notified immediately because hypocalcemia is a medical emergency.
3. A positive Chvostek’s sign can indicate a low calcium or magnesium level, but serum laboratory levels may have been drawn hours previously or may not be available.
4. If the client does have hypocalcemia, this may be ordered, but it is not implemented prior to assessment.

Question 32

The nurse is caring for a client diagnosed with diabetic ketoacidosis (DKA). Which statement best explains the scientific rationale for the client’s Kussmaul’s respirations? 1. The kidneys produce excess urine and the lungs try to compensate.

2. The respirations increase the amount of carbon dioxide in the bloodstream.
3. The lungs speed up to release carbon dioxide and increase the pH.
4. The shallow and slow respirations will increase the HCO3 in the serum.

Answer 32

1. Kussmaul’s respirations are the lung’s attempt to maintain the narrow range of pH compatible with human life. The respiratory system reacts rapidly to changes in pH.
2. Respiration is the act of moving oxygen and carbon dioxide. Kussmaul’s respirations are rapid and deep and allow the client to exhale carbon dioxide.
3. The lungs attempt to increase the blood pH level by blowing off the carbon dioxide (carbonic acid).
4. HCO3 (sodium bicarbonate) is an alkaline (base) substance regulated by the kidneys and is part of the metabolic buffer system, not a respiratory system buffer. The excretion and retention of carbon dioxide (CO2) are regulated by the lungs and therefore a part of the respiratory buffer system.

Question 33

The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? Select all that apply.

1. Place the solution on an IV pump at the prescribed rate.
2. Monitor blood glucose every six (6) hours.
3. Weigh the client weekly, first thing in the morning.
4. Change the IV tubing every three (3) days.
5. Monitor intake and output every shift.

Answer 33

1. TPN is a hypertonic solution with enough calories, proteins, lipids, electrolytes, and trace elements to sustain life. It is administered via a pump to prevent too-rapid infusion.
2. TPN contains 50% dextrose solution; therefore, the client is monitored to ensure the pancreas is adapting to the high glucose levels.
3. The client is weighed daily, not weekly, to monitor for fluid overload.
4. The IV tubing is changed with every bag because the high glucose level can cause bacterial growth.
5. Intake and output are monitored to observe for fluid balance.

Question 34

The client has received IV solutions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the IV site is tender to palpation and a red streak has formed. Which intervention should the nurse implement first?

1. Start a new IV in the right hand.
2. Discontinue the intravenous line.
3. Complete an incident record.
4. Place a warm washrag over the site.

Answer 34

1. A new IV will be started in the right hand after the IV is discontinued.
2. The client has signs of phlebitis and the IV must be removed to prevent further complications.
3. Depending on the health-care facility, this may or may not be done, but client care comes before documentation.
4. A warm washrag placed on an IV site sometimes provides comfort to the client. If this is done, it should be done for 20 minutes four (4) times a day.

Question 35

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients. Which nursing intervention should the nurse perform?

1. Measure the client’s output from the indwelling catheter.
2. Record the client’s intake and output on the I & O sheet.
3. Instruct the client on appropriate fluid restrictions.
4. Provide water for a client diagnosed with diabetes insipidus.

Answer 35

1. The UAP can empty the catheter and measure the amount.
2. The UAP can record intake and output on theI&Osheet.
3. The nurse cannot delegate teaching.
4. The client has a disease, but all the UAP is being asked to do is take water to the client.

Question 36

The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor?

1. Serum calcium.
2. Serum phosphorus.
3. Serum potassium.
4. Serum sodium.

Answer 36

1. Serum calcium is decreased in conditions such as osteoporosis or post–thyroid surgery, but not in vomiting and diarrhea.
2. Serum phosphorus levels are altered in acute and chronic renal failure or diabetic ketoacidosis, among other conditions, but not with acute fluid losses from the gastrointestinal tract.
3. Clients lose potassium from the GI tract or through the use of diuretic medications. Potassium imbalances can lead to cardiac arrhythmias.
4. The body is not at risk from losing sodium from these sources as it is with potassium.

Question 37

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first?

1. Start an IV with a 20-gauge catheter.
2. Initiate antibiotic therapy IVPB.
3. Collect a urine specimen for culture.
4. Change the indwelling catheter.

Answer 37

1. The first action is to get a viable urine culture so the causative pathogen can be identified. An IV should be started, but this is not the first action.
2. Initiating an IV antibiotic is priority, but obtaining a culture is done first to make sure the HCP can treat the causative organism.
3. This is not the first intervention since the culture will be obtained when the new catheter has been inserted.
4. Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis.

Question 38

The nurse is inserting an indwelling catheter into a female client. Which interventions should be implemented? Rank in the order of performance.

1. Explain the procedure to the client.
2. Set up the sterile field.
3. Inflate the catheter bulb.
4. Place absorbent pads under the client.
5. Clean the perineum from clean to dirty with Betadine.

Answer 38

In order of performance: 1, 4, 2, 3, 5.

1. The procedure should be explained to the client.
2. Incontinence pads should be placed under the client before beginning the sterile part of the procedure.
3. The sterile field must be set up prior to checking the bulb and cleaning the client’s perineum.
4. The bulb of the catheter should be tested to make sure it will inflate and deflate prior to inserting the catheter into the client.
5. During the procedure, the perineum is swiped with Betadine swabs from front to back and also down the middle, then side to side with new swabs (clean to dirty).

Question 39

The nurse performs bladder irrigation through an indwelling catheter. The nurse instilled 90 mL of sterile normal saline. The catheter drained 710 mL. What is the client’s output? ________

Answer 39

620 mL of urine.

The amount of sterile normal saline is subtracted from the total volume removed from the catheter.

Question 40

The nurse is examining a 15-year-old female who is complaining of pain, frequency, and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client?

1. “When was your last menstrual cycle?”
2. “Have you noticed any change in the color of the urine?”
3. “Are you sexually active?”
4. “What have you taken for the pain?”

Answer 40

1. This could be asked with a parent in the room, and the nurse should receive a truthful answer.
2. There is no reason the client should not answer this question in the presence of the parent.
3. These are symptoms of cystitis, a bladder infection which may be caused by sexual intercourse as a result of the introduction of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent.
4. This information could be obtained in front of the parent.

Question 41

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first?

1. A midstream urine for culture.
2. A sonogram of the kidney.
3. An intravenous pyelogram for renal calculi.
4. A CT scan of the kidneys.

Answer 41

1. Fever, chills, and costovertebral pain are symptoms of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis.
2. A sonogram of the kidney might be ordered if the client has recurrent UTIs to determine if a physical obstruction is causing the recurrent infections, but not as the first diagnostic procedure.
3. An intravenous pyelogram (IVP) is rarely used to determine pyelonephritis because the results are negative 75% of the time in clients diagnosed with acute pyelonephritis.
4. A CT scan might be ordered if other tests have not been conclusive.

Question 42

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis?

1. The client has fever, chills, flank pain, and dysuria.
2. The client complains of fatigue, headaches, and increased urination.
3. The client had a group B beta-hemolytic strep infection last week.
4. The client has an acute viral pneumonia infection.

Answer 42

1. Fever, chills, flank pain, and dysuria are symptoms of acute pyelonephritis, not chronic pyelonephritis.
2. Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis.
3. Group B beta-hemolytic streptococcus infections cause acute glomerulonephritis.
4. Acute viral pneumonia is a cause of acute glomerulonephritis.

Question 43

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI?

1. Clean the perineum from back to front after a bowel movement.
2. Take warm tub baths instead of hot showers daily.
3. Void immediately preceding sexual intercourse.
4. Avoid coffee, tea, colas, and alcoholic beverages.

Answer 43

1. The perineum should be cleaned from front to back after a bowel movement to prevent fecal contamination of the urethral meatus.
2. The temperature of the water does not matter, but the client should take showers instead of baths to prevent bacteria in the bathwater from entering the urethra.
3. Voiding immediately after, not before, sexual intercourse uses the action of the urine passing through the urethra to the outside of the body to flush bacteria from the urethra that might have been introduced during intercourse.
4. Coffee, tea, cola, and alcoholic beverages are urinary tract irritants.

Question 44

The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition?

1. The client must be treated aggressively to prevent maternal/fetal complications.
2. The nurse can force the client to drink fluids and avoid nausea and vomiting.
3. The client will be dehydrated and there won’t be sufficient blood flow to the baby.
4. Pregnant clients historically are afraid to take the antibiotics as ordered.

Answer 44

1. A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications.
2. The nurse cannot “force” a client to drink, and forcing fluids could result in nausea and vomiting, not prevent it.
3. The client may or may not be dehydrated.
4. Pregnant clients have a right to be concerned about taking medications, but most are comfortable taking medications prescribed by the obstetrician.

Question 45

The nurse is discharging a client with a health-care facility acquired urinary tract infection. Which information should the nurse include in the discharge teaching?

1. Limit fluid intake so the urinary tract can heal.
2. Collect a routine urine specimen for culture.
3. Take all the antibiotics as prescribed.
4. Tell the client to void every five (5) to six (6) hours.

Answer 45

1. The function of the urinary tract is to process fluids and wastes from the body. Limiting its functioning will increase the problem, not help the problem.
2. A routine urine specimen is not a clean voided specimen and cannot be used for culture.
3. The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics.
4. The client should be taught to void every two (2) to three (3) hours and to empty the bladder completely. This prevents overdistention of the bladder wall and resulting compromised blood supply, either of which predisposes the client to developing a UTI.

Question 46

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal?

1. The client will have a blood pressure within normal limits.
2. The client will show no protein in the urine.
3. The client will maintain normal renal function.
4. The client will have clear lung sounds.

Answer 46

1. Blood pressure within normal limits is a short-term goal.
2. Lack of protein in the urine is a short-term goal.
3. A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.
4. Clear lung sounds indicate the client has been able to process fluids and excrete them from the body. Preventing pulmonary edema is a short-term goal.

Question 47

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse?

1. The blood urea nitrogen is 15 mg/dL.
2. The creatinine level is 1.2 mg/dL.
3. The glomerular filtration rate is 40 mL/min.
4. The 24-hour creatinine clearance is 100 mL/min.

Answer 47

1. Normal blood urea nitrogen levels are 7 to 18 mg/dL or 8 to 20 mg/dL for clients older than age 60 years.
2. Normal creatinine levels are 0.6 to 1.2 mg/dL.
3. Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity.
4. Normal creatinine clearance is 85 to 125 mL/min for males and 75 to 115 mL/min for females.

Question 48

The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for
90 days. Which statement is the scientific rationale for prescribing this medication?
1. The antibiotic will treat the bladder spasms that accompany a urinary tract
infection.
2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial
growth.
3. In three (3) months, the client should be rid of all bacteria in the urinary tract.
4. The HCP is providing the client with enough medication to treat future
infections.

Answer 48

1. Antibiotics may indirectly treat bladder spasms if the spasms are caused by an infection, but this is not the reason for prescribing the antibiotic in this manner.
2. Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily medication to suppress the bacterial growth. The prescription will be refilled after the 90 days and continued.
3. Clients who develop chronic infections may never be free of the bacteria.
4. HCPs do not usually prescribe PRN prescriptions for antibiotics.

Question 49

The nurse empted 2,000 mL from the drainage bag of a continuous irrigation of a client who had a transurethral resection of the prostate (TURP). The amount of irrigation in the bag hanging was 3,000 mL at the beginning of the shift. There was 1,800 mL left in the bag eight (8) hours later. What is the correct urine output at the end of the eight (8) hours? _________

Answer 49

800 mL.

First, determine the amount of irrigation fluid:
3,000 − 1,800 = 1,200 mL of irrigation fluid
Then, subtract 1,200 mL of irrigation fluid from the drainage of 2,000 mL to determine the urine output:
2,000 − 1,200 = 800 mL of urine output

Question 50

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement?

1. Remove the indwelling catheter.
2. Titrate the NS irrigation to run faster.
3. Administer protamine sulfate IVP.
4. Administer vitamin K slowly.

Answer 50

1. The indwelling catheter should not be removed because doing so may result in edema, which, in turn, may obstruct the urethra and not allow the client to urinate.
2. Increasing the irrigation fluid will flush out the clots and blood.
3. Protamine is the reversal agent for heparin, an anticoagulant.
4. Vitamin K is the reversal agent for the anticoagulant warfarin (Coumadin).

Question 51

Which data support to the nurse the client’s diagnosis of acute bacterial prostatitis?

1. Terminal dribbling.
2. Urinary frequency.
3. Stress incontinence.
4. Sudden fever and chills.

Answer 51

1. Terminal dribbling is a symptom of BPH.
2. Urinary frequency is a sign of a UTI.
3. Stress incontinence occurs in women who urinate when coughing, running, or jumping.
4. Clients with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients with chronic prostatitis have milder symptoms.

Question 52

Which intervention should the nurse include when preparing a teaching plan for the client with chronic prostatitis?

1. Sit in a warm sitz bath for 10 to 20 minutes several times daily.
2. Sit in the chair with the feet elevated for two (2) hours daily.
3. Drink at least 3,000 mL of oral fluids, especially tea and coffee, daily.
4. Stop broad-spectrum antibiotics as soon as the symptoms subside.

Answer 52

1. The client should sit in a warm sitz bath for 10 to 20 minutes several times each day to provide comfort and assist with healing.
2. Clients should avoid sitting for extended periods because it increases the pressure.
3. Oral fluids should be consumed to satisfy thirst but not to push fluids to dilute the medication levels in the bladder. Broad-spectrum antibiotics are administered for 10 to 14 days and
4. should be not stopped until all medications are taken by the client.

Question 53

Which nursing diagnosis is priority for the client who has undergone a TURP?

1. Potential for sexual dysfunction.
2. Potential for an altered body image.
3. Potential for chronic infection.
4. Potential for hemorrhage.

Answer 53

1. TURPs can cause a sexual dysfunction, but if there were a sexual dysfunction, it is not be priority over a physiological problem such as hemorrhaging.
2. This is not a life-threatening problem.
3. This client has had this problem preoperatively.
4. This is a potentially life-threatening problem.

Question 54

Which statement indicates discharge teaching has been effective for the client who is postoperative TURP?

1. “I will call the surgeon if I experience any difficulty urinating.”
2. “I will take my Proscar daily, the same as before my surgery.”
3. “I will continue restricting my oral fluid intake.”
4. “I will take my pain medication routinely even if I do not hurt.”

Answer 54

1. This indicates the teaching is effective.
2. Clients do not need to take Proscar postoperatively.
3. There is no reason to restrict the client’s fluid intake.
4. Pain medication should be taken as needed.

Question 55

The client is one (1) day postoperative TURP. Which task should the nurse delegate to the UAP?

1. Increase the irrigation fluid to clear clots from the tubing.
2. Elevate the scrotum on a towel roll for support.
3. Change the dressing on the first postoperative day.
4. Teach the client how to care for the continuous irrigation catheter.

Answer 55

1. This intervention requires analysis and should not be delegated.
2. Elevating the scrotum on a towel for support is a task which can be delegated to the UAP.
3. The surgeon changes the first dressing; therefore, this cannot be delegated. A TURP does not have a dressing.
4. The nurse is responsible for teaching.

Question 56

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement first?

1. Call the surgeon to inform the HCP of the client’s complaint.
2. Administer the client a narcotic medication for pain.
3. Explain to the client this sensation happens frequently. 4. Assess the continuous irrigation catheter for patency.

Answer 56

1. The nurse should not call a surgeon until all assessment is completed.
2. A pain medication should not be adminis- tered until the cause of the problem is determined and all complications are ruled out.
3. Telling a client that what he is experiencing is expected without assessing the situation is dangerous.
4. The nurse should always assess any complaint before dismissing it as a commonly occurring problem.

Question 57

The client who is postoperative TURP asks the nurse, “When will I know if I will be able to have sex after my TURP?” Which response is most appropriate by the nurse?

1. “You seem anxious about your surgery.”
2. “Tell me about your fears of impotency.”
3. “Potency can return in six (6) to eight (8) weeks.”
4. “Did you ask your doctor about your concern?”

Answer 57

1. The client wants information and the nurse should provide facts.
2. The client wants information and the nurse should provide facts.
3. This is usually the length of time clients need to wait prior to having sexual intercourse; this is the information the client wants to know.
4. The client may need to talk with his surgeon, but it should be after the nurse answers the client’s question.

Question 58

The client asks, “What does an elevated PSA test mean?” On which scientific rationale should the nurse base the response?

1. An elevated PSA can result from several different causes.
2. An elevated PSA can be only from prostate cancer.
3. An elevated PSA can be diagnostic for testicular cancer.
4. An elevated PSA is the only test used to diagnose BPH.

Answer 58

1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.
2. An elevated PSA does not indicate only prostate cancer.
3. PSA does not diagnose testicular cancer.
4. An elevated PSA and digital examination are used in combination to diagnose BPH or prostate cancer.

Question 59

The client returned from surgery after having a TURP and has a P 110, R 24, BP 90/40, and cool and clammy skin. Which interventions should the nurse implement?
Select all that apply.
1. Assess the urine in the continuous irrigation drainage bag.
2. Decrease the irrigation fluid in the continuous irrigation catheter.
3. Lower the head of the bed while raising the foot of the bed.
4. Contact the surgeon to give an update on the client’s condition. 5. Check the client’s postoperative creatinine and BUN.

Answer 59

1. The nurse should assess the drain postoperatively.
2. The client is hemorrhaging, so the nurse should increase the irrigation fluid to clear the red urine, not decrease the rate.
3. The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system.
4. The surgeon needs to be notified of the change in condition.
5. These laboratory values assess kidney function, not the circulatory system, so this is not an appropriate intervention.

Question 60

The nurse is caring for a client with a TURP. Which expected outcome indicates the client’s condition is improving?

1. The client is using the maximum amount allowed by the PCA pump.
2. The client’s bladder spasms are relieved by medication.
3. The client’s scrotum is swollen and tender with movement.
4. The client has passed a large, hard, brown stool this morning.

Answer 60

1. Using the maximum amount of medication does not indicate the client is achieving pain management.
2. Bladder spasms are common, but being relieved with medication indicates the condition is improving.
3. Scrotal edema and tenderness do not indicate improvement.
4. Clients are administered laxatives or stool softeners to prevent constipation, which could cause increased pressure.

Question 61

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement?

1. Encourage the client to eat a low-purine diet and limit foods such as organ meats.
2. Explain the importance of not drinking water two (2) hours before bedtime.
3. Discuss the importance of limiting vitamin D–enriched foods.
4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

Answer 61

1. This is appropriate for the client who has uric acid stones.
2. The nurse should recommend drinking one (1) to two (2) glasses of water at night to prevent concentration of urine during sleep.
3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract.
4. This is a treatment for an existing renal stone, not a discharge teaching intervention for a client who has successfully passed a renal calculus.

Question 62

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first?

1. Monitor the client’s urinary output.
2. Assess the client’s pain and rule out complications.
3. Increase the client’s oral fluid intake.
4. Use a safety gait belt when ambulating the client.

Answer 62

1. The client’s urinary output should be monitored, but it is not the first nursing intervention.
2. Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope.
3. Increased fluid increases urinary output, which will facilitate movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention.
4. Ambulation will help facilitate movement of the renal stone through the ureter and safety is important, but it is not the first intervention.

Question 63

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure?

1. Ask if the client is allergic to shellfish or iodine.
2. Keep the client NPO eight (8) hours prior to the ultrasound.
3. Ensure the client has a signed informed consent form.
4. Explain the test is noninvasive and there is no discomfort.

Answer 63

1. An ultrasound does not require administration of contrast dye.
2. Food, fluids, and ordered medication are not restricted prior to this test.
3. This is not an invasive procedure, so a signed consent is not required.
4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied which produces sound waves, resulting in a picture.

Question 64

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone?

1. Dull, aching flank pain and microscopic hematuria.
2. Nausea; vomiting; pallor; and cool, clammy skin.
3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

Answer 64

1. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney.
2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.
3. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder.
4. Kidney stones and bladder stones may produce no signs/symptoms, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter.

Question 65

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply.

1. Check for the ordered diet and medication modifications.
2. Instruct the client to urinate, and discard this urine when starting collection.
3. Collect all urine during 24 hours and place in appropriate specimen container.
4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

Answer 65

1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid.
2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty.
3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result.
4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized.
5. The nurse can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates.

Question 66

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client?

1. Fluid volume loss.
2. Knowledge deficit.
3. Impaired urinary elimination.
4. Alteration in comfort.

Answer 66

1. The client’s fluid volume is increased and there is usually not a fluid volume loss.
2. Knowledge deficit is important to help prevent future renal calculi, but this is not priority when the client is in pain, which will occur with an acute episode.
3. Impaired urinary elimination may occur, but it is not priority for the client with an acute episode of calculi.
4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.

Question 67

The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP?

1. Monitor the amount, color, and consistency of urine output.
2. Teach the client about care of the indwelling Foley catheter.
3. Assist the client to the car when being discharged home.
4. Take the client’s postprocedural vital signs.

Answer 67

1. The urine must be assessed for bleeding and cloudiness. Initially the urine is bright red, but the color soon diminishes and cloudiness may indicate an infection. This assessment should not be delegated to a UAP.
2. Teaching cannot be delegated to a UAP. The nurse should teach and evaluate the effectiveness of the teaching.
3. The UAP could assist the client to the car once the discharge has been completed.
4. The kidney is highly vascular. Hemorrhag- ing and resulting shock are potential com- plications of lithotripsy, so the nurse should not delegate vital signs postprocedure.

Question 68

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation?

1. “I should increase my fluid intake, especially in warm weather.”
2. “I should eat foods containing cocoa and chocolate.”
3. “I will walk about a mile every week and not exercise often.”
4. “I should take one (1) vitamin a day with extra calcium.”

Answer 68

1. An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate.
2. Cocoa and chocolate are high in calcium and should be avoided or the amount should be decreased to help prevent formation of calcium phosphate renal stones.
3. Physical activity prevents bone absorption and possible hypercalciuria; therefore, the nurse should instruct the client to walk daily to help retain calcium in bone.
4. The renal calculi are caused by calcium; therefore, the client should not increase calcium intake.

Question 69

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi?

1. Assess the client’s neurological status every two (2) hours.
2. Strain all urine and send any sediment to the laboratory.
3. Monitor the client’s creatinine and BUN levels.
4. Take a 24-hour dietary recall during the client interview.

Answer 69

1. Assessment is important, but the neurological system is not priority for a client with a urinary problem.
2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone.
3. These are laboratory studies evaluating kidney function, but they are not pertinent when passing a renal stone. These values do not elevate until at least half the kidney function is lost.
4. A dietary recall can be done to determine what types of foods the client is eating which may contribute to the stone formation, but it is not the most important intervention.

Question 70

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client?

1. Increase water intake for the next 24 hours.
2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen.
3. Use a sterile 4 × 4 gauze to strain the client’s urine.

Answer 70

1. The client needs to be evaluated for a possible urinary tract infection, which may accompany renal calculi. Therefore, the clinic nurse should not give advice without knowing what is wrong with the client.
2. The nurse should not recommend any medication (even Tylenol) unless the nurse is absolutely sure what is wrong with the client.
3. A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI.
4. The client needs to strain the urine if there is a possibility of renal calculi, which these signs/symptoms do not support. Further diagnostic testing is needed to determine the presence of renal calculi.

Question 71

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse?

1. A serum potassium level of 3.8 mEq/L.
2. A urinalysis shows microscopic hematuria.
3. A creatinine level of 0.8 mg/100 mL.
4. A white blood cell count of 14,000/mm3.

Answer 71

1. This potassium level is within normal limits, 3.5 to 5.5 mEq/L.
2. Hematuria is not uncommon after removal of a kidney stone.
3. A normal creatinine level is 0.8 to 1.2 mg/100 mL.
4. The white blood cell count is elevated; normal is 5,000 to 10,000/mm3.

Question 72

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence?

1. Beer and colas.
2. Asparagus and cabbage.
3. Venison and sardines.
4. Cheese and eggs.

Answer 72

1. Beer and colas are foods high in oxalate, which can cause calcium oxalate stones.
2. Asparagus and cabbage are foods high in oxalate, which can cause calcium oxalate stones.
3. Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.
4. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones.

Question 73

The nurse is caring for clients on a renal surgery unit. After the afternoon report, which client should the nurse assess first?
1. The male client who just returned from a CT scan who states he left his glasses in
the x-ray department.
2. The client who is one (1) day postoperative and has a moderate amount of serous
drainage on the dressing.
3. The client who is scheduled for surgery in the morning and wants an explanation
of the operative procedure before signing the permit.
4. The client who had ileal conduit surgery this morning and has not had any
drainage in the drainage bag.

Answer 73

1. This client does not need to be assessed first. A ward secretary can call the department and check on the glasses.
2. A moderate amount of serous drainage is expected after a surgery. Serous drainage is pale-yellow body fluid. Sanguineous is the term used to describe bloody drainage.
3. The nurse is not responsible for informing the client about operative procedures. The surgeon should be notified to see this client and provide the explanation.
4. An ileal conduit is a procedure diverting urine from the bladder and provides an alternate cutaneous pathway for urine to exit the body. Urinary output should always be at least 30 mL/hr. This client should be assessed to make sure the stents placed in the ureters have not become dislodged or blocked.

Question 74

Which modifiable risk factor should the nurse identify for the development of cancer of the bladder in a client?

1. Previous exposure to chemicals.
2. Pelvic radiation therapy.
3. Cigarette smoking.
4. Parasitic infections of the bladder.

Answer 74

1. The client has already been exposed; this cannot be undone.
2. Pelvic radiation is prescribed for cancer in the abdomen. It is a life-saving procedure, but one of the risks of radiation therapy is the development of a secondary cancer.
3. Cigarette smoke contains more than 400 chemicals, 17 of which are known to cause cancer. The risk is directly proportional to the amount of smoking.
4. Clients may be unaware of a parasitic infection of the bladder for some time prior to diagnosis, but it is not a risk factor for cancer of the bladder.

Question 75

The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included?

1. Demonstrate turn, cough, and deep breathing.
2. Explain a bag will drain the urine from now on.
3. Instruct the client on the use of a PCA pump.
4. Take the client to the ICU so the client can become familiar with it.

Answer 75

1. Any client undergoing general anesthesia should be taught to turn, cough, and deep breathe to prevent pulmonary complica- tions. This is not specific to a urinary di- version procedure.
2. A urinary diversion procedure involves the removal of the bladder. In a cutaneous procedure, the ureters are implanted in some way to allow for stoma formation on the abdominal wall, and the urine drains into a pouch. There are numerous methods used for creating the stoma.
3. Many clients with multiple types of procedures use PCA pumps to control pain after surgery.
4. This should be done for any client who is expected to need intensive care postoperatively.

Question 76

The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instruction should the nurse provide the client about the pretherapy routine?

1. Instruct the client to remain NPO after midnight before the procedure.
2. Explain the use of chemotherapy in bladder cancer.
3. Teach the client to administer Neupogen, a biologic response modifier.
4. Have the client take Tylenol, an analgesic, before coming to the clinic

Answer 76

1. The client will have medication instilled in the bladder which must remain in the bladder for a prescribed length of time. For this reason, the client must remain NPO before the procedure.
2. Informed consent is important to do when informing the client about chemotherapy, but this is done when the client gives consent to receiving intravesical chemotherapy, not as part of the pretherapy routine.
3. The advantage of administering chemotherapy intravesically is systemic side effects of bone marrow suppression are avoided. Neupogen is used to stimulate the production of white blood cells so a client is not at risk for developing an infection.
4. The procedure is not painful, so an analgesic is not needed.

Question 77

The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care?

1. Provide meticulous skin care and pouching.
2. Apply sterile drainage bags daily.
3. Monitor the pH of the urine weekly.
4. Assess the stoma site every day.

Answer 77

1. Urine is acidic, and the abdominal wall tissue is not designed to tolerate acidic environments. The stoma is pouched so urine will not touch the skin.
2. Urinary diversion drainage bags are changed every four (4) to five (5) days so the skin can remain intact; the bags should be clean but not sterile.
3. The urine will have the normal pH of all urine; it is not necessary to monitor the pH.
4. The stoma should be assessed a minimum of every two (2) hours initially, then every four (4) hours.

Question 78

The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which intervention should be assigned to the LPN?

1. Assessment of the client who has had a Kock pouch procedure.
2. Monitoring of the postop client with a WBC of 22,000/mm3.
3. Administration of the prescribed antineoplastic medications.
4. Care for the client going for an MRI of the kidneys.

Answer 78

1. Assessment cannot be assigned to an LPN, no matter how knowledgeable the LPN.
2. This client has the laboratory symptoms of an infection; therefore, the nurse should assess and care for this client.
3. Antineoplastic medication is administered only by a qualified registered nurse.
4. It is in the scope of practice for the LPN to care for this client.

Question 79

The male client diagnosed with metastatic cancer of the bladder is emaciated and refuses to eat. Which nursing action is an example of the ethical principle of paternalism?

1. The nurse allows the client to talk about not wanting to eat.
2. The nurse tells the client if he does not eat, a feeding tube will be placed.
3. The nurse consults the dietitian about the client’s nutritional needs.
4. The nurse asks the family to bring favorite foods for the client to eat.

Answer 79

1. This is therapeutic communication and is allowing the client autonomy, but it is not an example of paternalism.
2. Paternalism is deciding for the client what is best, similar to a parent making decisions for a child. Feeding a client, as with a feeding tube, without the client wishing to eat is paternalism.
3. Consulting with a dietitian about the nutritional needs of a client is an appropriate nursing intervention, but it does not represent any ethical principle.
4. This is an excellent intervention, but it does not represent any ethical principle.

Question 80

The client diagnosed with cancer of the bladder states, “I have young children. I am too young to die.” Which statement is the nurse’s best response?

1. “This cancer is treatable and you should not give up.”
2. “Cancer occurs at any age. It is just one of those things.”
3. “You are afraid of dying and what will happen to your children.”
4. “Have you talked to your children about your dying?”

Answer 80

1. This is advising the client, a nontherapeutic technique.
2. This statement does not address the client’s feelings.
3. This is an example of restating, a therapeutic technique used to clarify the client’s feelings and encourage a discussion of those feelings.
4. The stem did not say the client was dying. The stem said the client thinks he or she is too young to die. A conversation to discuss the client’s death with the children may be premature.

Question 81

The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include in the teaching?

1. Have the client demonstrate catheterizing the stoma.
2. Instruct the client on how to pouch the stoma.
3. Explain the use of a bedside drainage bag at night.
4. Tell the client to call the HCP if the temperature is 99 ̊F or less.

Answer 81

1. A continent urinary diversion is a surgical procedure in which a reservoir is created to hold urine until the client can self-catheterize the stoma. The nurse should observe the client’s technique before discharge.
2. The purpose of creating a continent diversion is so the client will not need a pouch.
3. Clients with cutaneous diversions that drain constantly use a bedside drainage bag at night, not those with continent diversions.
4. The client should be taught to notify the HCP if the temperature is 100 ̊F or greater.

Question 82

Which information regarding the care of a cutaneous ileal conduit should the nurse discuss with the client?

1. Teach the client to instill a few drops of vinegar into the pouch.
2. Tell the client the stoma should be slightly dusky colored.
3. Inform the client large clumps of mucus are expected.
4. Tell the client it is normal for the urine to be pink or red in color.

Answer 82

1. Vinegar will act as a deodorizing agent in the pouch and help prevent a strong urine smell.
2. The stoma should be pink and moist at all times. A dusky color indicates a compromised blood supply to the stoma, and the HCP should be notified immediately.
3. There will be mucus in the urine because of the tissue used to create the diversion, but large clumps of mucus could occlude the stoma or ureters.
4. Urinary drainage should be a pale yellow to amber color. The procedure does not change the color of the urine.

Question 83

The client is two (2) days post-ureterosigmoidostomy for cancer of the bladder. Which assessment data warrant notification of the HCP by the nurse?

1. The client complains of pain at a “3,” 30 minutes after being medicated.
2. The client complains it hurts to cough and deep breathe.
3. The client ambulates to the end of the hall and back before lunch.
4. The client is lying in a fetal position and has a rigid abdomen.

Answer 83

1. A complaint of a “3” on a 1-to-10 pain scale is expected after medication and does not warrant notifying the HCP.
2. Pain on coughing and deep breathing after surgery is expected.
3. This indicates the client is able to ambulate and is doing activities needed to recover.
4. The client is drawn up in a position which relieves pressure off the abdomen; a rigid abdomen is an indicator of peritonitis, a medical emergency.

Question 84

The female client diagnosed with bladder cancer who has a cutaneous urinary diversion states, “Will I be able to have children now?” Which statement is the nurse’s best response?

1. “Cancer does not make you sterile, but sometimes the therapy can.”
2. “Are you concerned you can’t have children?”
3. “You will be able to have as many children as you want.”
4. “Let me have the chaplain come to talk with you about this.”

Answer 84

1. This client is asking for information and should be provided factual information. The surgery will not make the client sterile, but chemotherapy can induce menopause and radiation therapy to the pelvis can render a client sterile.
2. This is a therapeutic response, but the client asked for information.
3. This is a false statement and lying to the client.
4. This is outside the realm of a chaplain.